Question:
Should I Call My Insurance Company or Let My Surgeon's Office Deal With It- I'm working through the

I am currently in the process of obtaining a consult with my surgeon. In order to get scheduled for a consult you must first attend a group informational meeting. I will be attending the next meeting which is in just two weeks. I will then be scheduled for a consult. I'm guessing that it will take at least two months to get an appointment as the surgeon is very busy. I've been reading everything I can get my hands on about the surgery and insurance. I have BCBS PPO, which is very good insurance but I'm starting to panic. I'm so terribly afraid that for some reason or another I will be denied. When I called the surgeons office to ask about the surgery and see where to start I told the receptionist what type of ins. that I have and she said it should be no problem. She did know that the company requires a three month medically supervised diet so she suggested that I begin that. I'm now in month two of this...I've also prepared a past diet history and am working on a personal letter to the ins. company stating all the reasons I need the surgery. When should I call them personally or should I just let the surgeons office handle all of that?    — Rhonda Y. (posted on March 6, 2003)

March 5, 2003
Hi Rhonda. I understand your apprehension, but I would let the Dr's office handle it at this point. They deal with this sort of thing everyday. You will, of course, want to know what they are doing, when things are submitted, etc. You may need to get involved at a later stage in the game, but for now, just let them do their job. I know it is frustrating playing the "waiting game" but you will have more of an impact if you get involved "as necessary" instead of right off the bat. The surgeons offices are generally really good about handling the insurance end. Renee
   — Renee D.

March 6, 2003
After my consult I started calling the insurance company. I called once a week. When it had been 9 weeks the lady I talked to sent my case to her manager. I was approved 2 days later.
   — Paula G.

March 6, 2003
Hi Rhonda, I know how you feel. I have BC/BS PPO and got a copy of the gastric bypass policy. (Remember each BC/BS PPO is different) In looking at it, it was obivous I met the criteria, however I was still terrified the I would be denied. Despite what the doctor's office told me. This is the worse part of the process, I think. At this point I would let the Dr's office handle it but have your letter stating why you need the surgery ready just in case. I prepared for the worse (denial) and was approved in 2 days. The Dr's office is used to working with the insurance companies. They aren't going to do all that work if they don't think you have a chance at being approved. Hang in there. - Janine
   — jmusser

March 6, 2003
My suggestion would be to hold off calling the insurance company until everything is submitted for approval. Then when the Dr's office has submitted you can call the insurance company. This is "safety measure". 1) to make sure the Dr's office did as they said 2) to make sure the insurance company received it (i follow up on auth's everyday as part of my job duties and wish I could get a nickel for everytime they said they didn't receive the info) 3)with you (the insured) following up on the auth process, the insurance company will take notice and sometimes push it along faster. Good luck Robin - pre-op testing in process
   — Robin J.

March 6, 2003
Janine, how did you get a copy of the gastric bypass policy? Did you just call and ask for it? I've read our benefits book forward and backward and either it's not in there or I'm missing it somehow.
   — Rhonda Y.

March 6, 2003
I have a bcbs ppo and was approved within 3 weeks. My dr office handled all the paper work. I called them to find out when they submitted and once it was I called my ins. It went pretty easy. Good luck. Jamie
   — Jamie M.

March 7, 2003
It almost makes me cringe when I hear people ask plan specific insurance questions. Please do NOT think that because one BCBS PPO is one way that your's will be the same. Unless you work for the same employer, same location, at the same level as someone else...there's a very good chance that your plan is different in one way or another. Plus, BCBS PPO may offer WLS, but maybe your employer chose not to opt into that coverage. If you have a Plan booklet (EVERY participant is entitled to one), look up coverage of weightloss first. It may lead you into the right area for WLS. OR... call the insurance company and ask them what section you can find ALL of the details about coverage of the procedure. I have to say that I've heard more good about BCBS PPO than bad, but... just do what they say to do whether you think it's required or not. My insurance company required a LOT of stuff (which I was ready to do). But when the time came, the packet from the surgeon was so thorough that insurance excepted it. I was approved in 2 days. I had called in advance and gotten the name of the person who approves this procedure along with her direct fax number. It really came in handy!!! Good luck!
   — Diane S.

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